Provider Demographics
NPI:1821482258
Name:TARANEH F. NOORVASH DDS INC
Entity Type:Organization
Organization Name:TARANEH F. NOORVASH DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TARANEH
Authorized Official - Middle Name:FIROUZ
Authorized Official - Last Name:NOORVASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-442-9661
Mailing Address - Street 1:11645 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1060
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1708
Mailing Address - Country:US
Mailing Address - Phone:310-442-9661
Mailing Address - Fax:310-447-3867
Practice Address - Street 1:11645 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1060
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1708
Practice Address - Country:US
Practice Address - Phone:310-442-9661
Practice Address - Fax:310-447-3867
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TARANEH F. NOORVASH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40151261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental